Dear Doctor,
I\’ am 35 year old housewife with two children. For the last 2 years, I am having some problems with my throat. The symptoms generally are loss of voice while speaking; itchiness in the throat, continuous dry cough and whenever I drink cold water, the symptoms intensifies. I went to an ENT surgeon and the diagnosis was Chronic Granular Pharyngitis. I\’m taking Loratidine and Rabeperazole as medications. I\’m really very much worried about this problem as this has been depressing me a lot. Are there any medications or better way of treatment to this problem?
Mrs. Arathy Krishnan
Answer: The treatment for this condition involves some lifestyle modifications, medication and if those measures fail, then a simple laser surgery. It seems you are suffering from chronic granular pharyngitis, which is a very common debilitating problem. The medications you are taking are commonly prescribed for this condition. If this conservative form of treatment fails then there is a surgical option –Laser Cautery of throat -which may provide permanent relief. It is performed under Local anesthesia and take about 10-15 mnts to complete. There is no hospital stay involved.
In general, those suffering from granular pharyngitis must avoid alcohol; smoking and they should control acid reflex (GERD) and chronic sinusitis symptoms like post nasal drip.
What is Granular Pharyngitis?
It is a chronic inflammation of the mucous surfaces of the pharynx and adjacent tissues.
Phyaryngitis (sore throat) it is the painful inflammation of pharynx commonly due to bacterial or viral infection. It may or may not be associated with “Tonsillitis”. Mainly it is a viral – infection. Just 10% of cases may be due to bacterial or fungal infection or ingestion of chemicals and pollutants.
Throat is the gateway to the body\’s defense mechanism. It consists of Pharynx and larynx. The pharynx acts as a passage way for food from the mouth to the esophagus and as an air passage from the nasal cavity and mouth to the larynx. It also acts as a resonating chamber for the sounds produced in the larynx. Larynx is responsible for production of vocal sounds. It also serves as an air passage, conveying air from pharynx to the lungs. It is situated in front of the neck, above the trachea. Tonsils are a pair of glands situated on each side of the throat i.e. right and left. Adenoids are the collection of lymphatic tissue at the rear of the nose.
Causes
It may be the result of repeated attacks of the acute and sub acute pharyngitis , or it may come on gradually, the result of continued irritation from smoking or drinking. Very cold drinks or highly spiced food may also render one liable to this affection. Frequent Post nasal drip from sinusitis is a very frequent source of irritation. Another common cause is the frequent and injudicious use of the voice as in singers and those who strain the voice. Acid reflux from a disordered stomach (GERD) may also figure in producing the disease.
Clinical Findings
The lining the pharynx is inflamed with a vivid red or dusky color. The venules are dilated and tortuous and the mucous surface is studded with small, round, red granulations, the enlarged mucous follicles and covered with tenacious mucus, which is removed with difficulty. The lateral pharyngeal bands are hypertrophied. The tonsil may not be enlarged in fact it may be very small and fibrotic.
Symptoms
Frequent sore throat, not associated with fever is the classical symptom. The throat always feels dry, a hacking cough and mild to moderate dysphagia will be present. The voice is more or less husky.
On examination of the throat is characterized by marked swelling of the follicular tissue of the pharynx, which has a granular glazed appearance.
Throat swab culture test have been persistently negative, but, unfortunately, there has not been any opportunity for identification of virus infection.
Treatment
In beginning the treatment, the patient must clearly understand that all sources of irritation are to be avoided if a cure is needed. Smoking, the use of alcoholic drinks, highly seasoned food, drinking ice cold drinks and the prolonged use of the voice, are to be discontinued.
The illness is usually by resistant to any form of treatment, lozenges, gargles, and inhalants having practically no effect.
Home Remedies
and Gargle with salt water. You can add ¼ teaspoon turmeric powder.
and Drinking hot milk boiled with turmeric powder in the night before going to bed.
Management
1. Identification of cause and its correction. Avoid alcohol, tobacco, control of GERD, treat sinusitis, allergy
2. Warm saline gargles with turmeric
3. Mandl\’s throat paint is useful in preventing secondary infections.
4. Betadine®gargle
5. Short course of broad spectrum antibiotic, antihistamines and deflazacort might give temporary relief.
6. Laser treatment Granular Pharynx-laser cautery (vaporization) of the granular follicles in the pharynx will give good relief.
How Laser Treatment is done
The surgical procedure, called Laser Granular Ablation (LGA), uses a CO2 laser to surgically remove, reduce or vaporize the granular follicles in the posterior pharyngeal wall and the hypertrophied lateral pharyngeal bands..
This laser procedure generally takes15 to 20 minutes and can be performed in an office setting. Those who have gag reflex it may have to be done under GA. The patient is seated on a dental type chair (see the picture) a local anesthetic is spray is used to anesthetize the back of the throat. The granule in the posterior pharyngeal wall are then cauterized, there is no pain, no infection and can get back to work without taking any leave. Very simple procedure can be done under local anesthesia. Takes only 10-20 mnts.
The cost is approximate Rs 5000.
Jubilee Hospital Trivandrum- Timing
Clinic hours: 8AM -1 PM Mon-Wed-Friday
(Operation Days: Tue-Thu-and Saturdays)
Patient can be seen on operation days with prior appointment from 2-4PM.
For Appointment– call 0471-2334561/62/63/64, 6452020,407822 Fax-0471-2330925
Email: drpaulose@yahoo.com
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